Clinton and Trump Stake Out Stark Differences on Obamacare in Second Debate

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Hillary Clinton and Donald Trump outlined their stark differences on health care Sunday night in their second presidential debate.

While Clinton repeated argument she used against Sen. Bernie Sanders of Vermont during the Democratic primaries that Congress and the White House must build on the Affordable Care Act despite its shortcomings and mounting financial travails, Trump vowed to take a wrecking ball to the 2010 legislation and start from scratch.

“Obamacare is a disaster,” Trump bellowed during the 90 minute town-hall meeting style debate on the campus of Washington University in St. Louis. “It will never work. It's very bad, very bad health insurance. Far too expensive.... We have to repeal it and replace it with something absolutely much less expensive and something that works, where your plan can actually be tailored.”

Trump was borderline incoherent in describing how he would replace Obamacare, fixating once again on a small-bore Republican proposal for encouraging health insurance sales across state lines to step up competition and bring down premiums. “We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing,” he said.

Trump also declared that Obamacare health insurance premiums are going up “68 percent, 59 percent, 71 percent,” although most common plans offered on state and federally run insurance exchanges will increase by an average of 9 percent, according to a July analysis by the Kaiser Family Foundation.

Ironically, it was Clinton’s husband, former President Bill Clinton, who handed Trump his most effective talking points. Bill Clinton told a crowd in Flint last week that Obamacare was the “craziest thing in the world” because it had flooded the insurance market with nearly 25 million previously uninsured Americans and then “doubled” their premiums and cut their coverage in half.

Bill Clinton spoke just weeks before Obamacare begins its fourth enrollment season amid mounting concerns about rising premiums and copayments. Trump and other GOP critics insist that Obamacare will collapse of its own weight, as Aetna, UnitedHealthcare, Blue Cross Blue Shield and other major insurers have begun pulling out of the market because of huge financial losses, and all but five of 23 non-profit co-ops created under the law have closed their doors.

The former president later tried to walk back his comments, declaring that the ACA had done “a world of good” and that for the first time more than 90 percent of Americans are benefiting from coverage.“But there is a group of people — mostly small business owners and employees — who make just a little too much money to qualify for Medicaid expansion or for the tax incentives who can't get affordable health insurance premiums in a lot of places,” he added. “And the reason is they're not in big pools. So they have no bargaining power."

Hillary Clinton for months has had to walk a fine line on health care reform. On the one hand, she has been obliged to defend the signature health insurance program of her chief political patron, President Obama, and she has used that stand to great effect in rallying support among African Americans and other minorities.

On the other hand, she has felt enormous pressure from Sanders and others on the left to broaden her perspective to the point that she is now advocating a government option on the Obamacare exchanges and even extending Medicare coverage to some people below the retirement age. Clinton has also proposed boosting government subsidies for out-of-pocket medical costs and has vowed to focus on reducing the cost of prescription drugs.

A recent study by the Commonwealth Fund and the RAND Corporation projected that 9.1 million additional people would qualify for health care coverage under Clinton’s campaign proposals — effectively slashing the current 11 percent rate of uninsured by half.

Not for the first time, Bill Clinton placed his wife in an awkward position with his initial, highly critical comments about Obamacare — even while there was considerable merit to what he said. Pressed by debate moderator Anderson Cooper of CNN Sunday night to say whether her husband was mistaken or was simply telling the truth, Hillary Clinton brushed past the question, noting that “he clarified what he meant.”

“Look, we are in a situation in our country where if we were to start all over again, we might come up with a different system,” she said. “But we have an employer-based system. That’s where the vast majority of people get their health care. And the Affordable Care Act was meant to try to fill the gap between people who were too poor and couldn’t put together any resources to afford health care, namely people on Medicaid.”

In making her case for a bipartisan effort to salvage Obamacare in the coming years, Clinton warned that a repeal of the law would jeopardize some of its most popular features, including a ban on insurers denying coverage to people because of pre-existing conditions, charging women more than men, and the requirement that insurers cover children up to the age of 26.

“We’ve got to get the costs down,” she said. “We’ve got to provide some additional help to small businesses. But if we repeal it and start over again, all those benefits I just mentioned are lost to everybody.”

Trump left no doubt that Obamacare would be history if he somehow can overcome Clinton’s growing lead in the polls in the final month of the campaign. But he promised he would preserve at least one key tenet of Obamacare — assuring coverage despite any pre-existing medical conditions. Yet Trump was vague as to how he and the Republicans could persuade insurers to continue to overlook applicants’ pre-existing conditions without preserving another key element of Obamacare, the so-called individual mandate requiring every American to acquire insurance or face a penalty — a component of the law that is roundly despised by the GOP.

“We’re going to be able to,” Trump insisted. “You’re going to have plans that are so good, because we’re going to have so much competition in the insurance industry. Once we break out — once we break out the lines and allow the competition to come.”

Washington Editor and D.C. Bureau Chief Eric Pianin is a veteran journalist who has covered the federal government, congressional budget and tax issues, and national politics. He spent over 25 years at The Washington Post.